The term “proctitis” describes a state of inflammation in the lining of the rectum. Patients with Proctitis may suffer from symptoms that overlap with many colon, rectal and anal conditions. Symptoms such as rectal pain, bleeding and loose bowel movements may develop acutely and worsen over time. Most causes may be traced to infection, inflammatory bowel disease, or radiation exposure. Proctitis related to inflammatory conditions of the bowel, like ulcerative colitis or crohn’s disease, frequently involve the colon as well. Treatment is usually medical in the form of topicals or oral medications. Proper evaluation usually with colonoscopy and biopsy or stool studies and cultures frequently confirm the diagnosis. In severe forms of ulcerative colitis or crohn’s disease, or refractory radiation proctitis, surgery may be indicated.
Proctitis has many potential causes but it is usually related to inflammatory bowel disease or infections. Additionally, often the colon is affected as well. Some of the common causes of proctitis with and without colitis include:
- Ulcerative proctitis (rectum alone) and ulcerative colitis (colon and rectum)
- Crohn’s disease
- Exposure to radiotherapy usually for prostate, vaginal, cervical or anal cancer
- Contraction of STDs such as gonorrhea, herpes, or chlamydia
- Infections from food borne or other gastrointestinal infections such as E. Coli, Salmonella or other bacteria, viruses or parasites
Proctitis can manifest in a variety of ways, especially since it frequently occurs in conjunction with colitis and other pathologies. The most common symptoms of proctitis include:
- Pain with bowel movements
- Deeper pain in the rectum
- Fecal urgency
- Rectal discharge, mucous or pus
- Bloody stools
- Frequent or constant sensation of needing to perform bowel movements
Symptoms may become noticeable in a variety of manors depending on the cause. They can present slowly and gradually. They may begin abruptly and progressively worsen. Proctitis may also be mild and relatively stable over long periods of time.
The diagnosis of proctitis typically involves an index of suspicion, as well as timely physical examination. Examination of the low rectum can be achieved quickly and comfortably with a small scope (anoscope) during the initial evaluation. Depending on the situation, further testing with stool studies and cultures, rectal cultures, endoscopic evaluation with flexible sigmoidoscopy or colonoscopy may be indicated to both find the cause and plan proper treatment.
Treatment for proctitis depends heavily on the specific cause. When infection is suspected and confirmed, antibiotic treatment is most effective. Cases related to radiation usually respond to enemas or suppositories. Some radiation cases require surgical treatment to control bleeding.
Cases that are related to ulcerative colitis or ulcerative proctitis generally respond to enemas, suppositories or oral medications. Crohn’s disease, the other main inflammatory bowel condition involves much of the same approach. Ultimately surgery may be necessary in severe cases.
Regardless of the causes, patients that have symptoms that suggest proctitis or other similar colorectal and anal conditions should seek medical care from a board certified colon and rectal surgeon to help diagnose and treat the condition. Frequently, care may then be coordinated with other doctors such as gastroenterologists, who specialize in the medical treatment of many gastrointestinal conditions.
The Saleeby & Wessels Proctology Approach
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